OP0118-HPR GAMING FOR ADHERENCE TO MEDICATION USING E-HEALTH IN RHEUMATOID ARTHRITIS (GAMER) STUDY – A RANDOMISED CLINICAL TRIAL
Authors: B. Pouls, C. Bekker, J. E. Vriezekolk, S. van Dulmen, B. van den Bemt
Journal: Annals of the Rheumatic Diseases (2022)

Background Effectiveness of pharmacological therapy in rheumatoid arthritis (RA) is limited by inadequate medication adherence. Medication adherence can be influenced by implicit attitudes of personal medication needs and concerns about adverse consequences. We targeted these implicit attitudes using a serious puzzle game. Objectives To assess the effectiveness of a serious game compared to usual care to improve adherence to disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA). Methods A multicentre randomised clinical trial was performed with a 3 month follow-up period.[1] Inclusion criteria were adulthood, RA diagnosis, use of DMARDs and possession of a smartphone/tablet. All participants received usual care. In addition, intervention participants were invited to play the serious puzzle game at will. The game was designed to influence players’ attitudes toward medication.[2] Collected data consisted of serious game play data, Compliance Questionnaire in Rheumatology (CQR), Beliefs about Medication Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI). Primary outcome was DMARD implementation adherence at three months assessed as the difference in proportion of non-adherent patients (&lt;80% taking adherence) between intervention and control group using the discriminant function of the CQR using the Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes between study groups where appropriate. Results 229 participants were randomised and 186 participants completed the study. Of the 85 intervention participants, 70 (82%) played the serious game for at least one hour. The serious game was played a median of 36 sessions with an average playtime of 25 minutes leading to a median overall playtime of 9.7 hours. A total of 59 (69%) intervention participants showed at least 40 days of gaming activity. Control group adherence (54%) and intervention group adherence (63%) based on the dichotomised CQR-score did not differ at three months (p = 0.26) (see Table 1). Neither was there a significant difference in CQR continuous score (p = 0.20), beliefs about medication differential score (p = 0.43) or clinical outcomes (HAQ: p = 0.97; RADAI: p = 0.90) (see Table 1). Table 1. Study outcomes at end-point (3 months) Control group (n=101 ) Intervention group (n=85 ) p-value Primary outcome Adherent no. (% )* 55 (54) 52 (63) 0.26 Secondary medication outcomes CQR continuous mean ± SD 75 ± 12 73 ± 11 0.20 BMQ-Specific NCD score mean ± SD 4.8 ± 4.2 5.3 ± 4.7 0.43 Secondary clinical outcomes RADAI score median [IQR] 2.5 [1.2 – 4.0] 2.5 [1.5 – 4.2] 0.90 HAQ score median [IQR] 0.8 [0.3 – 1.4] 0.6 [0.3 – 1.4] 0.97 Abbreviations: no. – number; SD – standard deviation; CQR – Compliance Questionnaire on Rheumatology; BMQ – Beliefs about Medication questionnaire; IQR – interquartile range * Percentage of the total number of participants excluding missing data. Conclusion This multicentre randomised clinical trial showed that a serious puzzle game aimed at reinforcing a positive attitude towards DMARDs was frequently played during three months. Playing the game did not improve medication adherence nor influenced beliefs about medication or clinical outcomes in RA patients. References [1] https://www.trialregister.nl/trial/7217 [2]Pouls B, Bekker CL, van Dulmen S, Vriezekolk JE, van den Bemt BJF. A serious puzzle game to enhance adherence to anti-rheumatic drugs in rheumatoid arthritis patients: systematic development using Intervention Mapping. JMIR Serious Games. 06/11/2021:31570 (forthcoming/in press) Disclosure of Interests Bart Pouls: None declared, Charlotte Bekker: None declared, Johanna E. Vriezekolk: None declared, Sandra van Dulmen: None declared, Bart van den Bemt Speakers bureau: UCB, Pfizer, Sanofi-Aventis, Galapagos, Amgen en Eli Lilly